Don’t ignore these Health Red Flags—Time for a Wake-Up Call! | Dr Pal

Understanding Type 1 and Type 2 Diabetes

[00:00] If you look at type 1 diabetic people, they are actually skinny. Yeah, type 1 diabetes is very usually skinny. People think that surgery is very very bad, very aggressive, but there is a road for them as well. Where it is needed, it is needed. Yes. Avoiding saturated fats is example like? Example would be animal fats would be cigarettes from 10 to 12 a day.

[00:20] With cancer risk increase? Not as much because you are already smoking 10 cigarettes but someone who is not smoking at all, you start asking the person to start smoking, it would increase drastically. If you are eating nuts and seeds and like you mentioned the 10 to 15 nuts per day, that will give you less than 30 grams. Indian cooking is mixed with oil a lot. Not of oil. And that's why you also see a dramatic

[00:40] improvement in terms of blood sugar level when you ask people to put whole food fan base within 21 days. The biggest problem sometimes they have is they get very hungry during snack time. Tips and tricks for that. So if you want a warmer snack, sundaals are a great option. If you want colder snacks then vegetables and air-fried sweet potatoes are a great option. So anything which

[01:00] fiber resistance touch. But now growing up has an issue with overeating, not mind-fulating, not chewing. Such a small thing, you don't pick it up. We are not supposed to be awake at night. And what people will say, we are tossing and turning, sleep is not coming. Work on the sleep. Start inculcating practices for healthy sleep. Don't use your bedroom

[01:20] for anything but sleep and sex. Don't do anything. Don't eat on your bedroom. Don't have the TV on. Don't use it as your workstation. It's mostly about the food. People have a laptop on the bed. Laptop on the bed, exactly. So stop and then make sure you have a sleep routine. Classically condition your mind in terms of if you don't have a routine, how will you fall asleep?

[01:40] Hi, Roshni. Hi. Hi, again. And our first episode was wonderful discussion about, you know, carb protein, fats and everything. So I wanted to translate that into an actual clinical patient. So when I can extract more information from you. Yes. Okay. So I'm going to present the patient to you.

Gastroparesis and Its Link to Diabetes

[02:00] So in this podcast we are going to talk about a diabetic patient and I will tell you a clinic patient that I saw in my office. So he came in with abdominal bloating and early fullness what we means is as soon as he eats he feels full and then

[02:20] Then this is a very common symptom that we usually see and most of the times with the ENSERP it could be ulcer on the stomach or if they are more than 50, 60 Asian patient then it could be pre-mening, mening, something like that. So early fullness and bloating is a cancer-setter at flag so we do an endoscopy. Endoscopy was good, everything was good then turned out to be

[02:40] He is a new answer diabetic. The reason that he is feeling early fullness as soon as he eats, he feels full is because the body is filled with sugar and the sugar is making the nerves not working properly. So the nerve supplying the stomach is not working to a point that it is paralyzed.

[03:00] So we call this as gastroparesis, stomach being paralyzed because of excess sugar in the body. And that was the first manifestation symptom for that particular patient. So then he asked me, I said, you know, the treatment is nothing gastroenterological at all. The first treatment is you need to decrease your

[03:20] level. So that your nerves can start acting again. So your A1c was 7.3 or something like that. But apparently it's been going on for a while. That's why he has that much amount of symptoms. I said bring it down to 6.4 somehow. If not, this symptom is not going

[03:40] So he said, okay, what should I do? I said, you know, you need a dietitian, you know, you need to understand everything. So let's say I refer that particular patient. He is like 45 years old and he comes to you. Many patients on that age are also pre-diabetic as well. What is the first thing that you do in your practice? The first thing which we do is ask the patient.

[04:00] has anyone taken the time to explain your what is diabetes? You put the blame back on the doctor. I think because doctors are busy we have our jobs. Of course that's really true. Yeah no but we don't have and I think just

[04:20] having the understanding of what diabetes is literally finding your cure because you understand now what is causing diabetes. And I've asked this to multiple patients through working with them as a nutritionist on my team and dieticians on my team. I've asked them so many times. I think one

[04:40] One out of 100 will tell us yes, but just imagine that ratio. It is so big and all the others will be fumbling with words. Yes sugar. Yes insulin. But they don't really know what is going on. So I think I'm going to try and break it down into very simple, easy to understand terms. And while I'm explaining it's not going to be scientific.

[05:00] because I'm really trying to explain to people what diabetes is. So imagine you're eating food, any food you're eating. Food is breaking down into these molecules called glucose or sugar, and that glucose stays in your blood. Now there's a problem with glucose in the blood. Glucose in the blood

[05:20] can cause a problem. But glucose is very, very important for functioning of everything if your heart has to beat, if you have to breathe, if your brain has to function, anything has to function, you need glucose. So glucose is not the villain. Glucose in the blood is the villain. So we need that part clarified. But like I said, because

[05:40] glucose is not the villain, it is actually the hero of your story, you need glucose to function, you will die without it. Glucose has to be taken up by your muscle cells to function. Correct. Okay. And this process of the glucose, glucose is over here, muscle cell is here. Process of the glucose entering the muscle cell will require a key like a door and

The Role of Insulin and Intramyocellular Fat in Diabetes

[06:00] You need to open the muscle cell, then the glucose will be able to enter. Without the door opening, it will not enter. And who opens the store? This key is this hormone called insulin, which is released in your pancreas. So when you're eating, pancreas are going into high alert and saying, we need to send the keys. You have to go and open the door.

[06:20] Without the dough, the glucose is going to stay in your blood and that's a problem. So the pancreas are releasing this thing called insulin, which is going and trying to then open the key. Now imagine you had a chewing gum stuck in the lock. The key is not going to work. So separate scenario, you're going home and you're trying to open

[06:40] your home door and the chewing gum is stuck in the lock. It's not opening. Is the key faulty? No. It's not the key. Is the door faulty? Will you leave and say I'm going to a different house, this house is not working? It's not. The problem is the chewing gum is there. We have to remove the chewing gum first. Then the key will work. There's no problem with regard to the door. Nothing.

[07:00] And the twingam needs to be removed. This twingam is what we term as intramyoscellular fat. So these fat cells in your muscle cells are blocking the insulin from doing its job. And because it's blocking the insulin from doing its job, the blood

[07:20] blood sugar, the glucose will stay in your blood causing a rise in your blood sugar. So when you're measuring and you're seeing the 200 blood sugar, that's because it's not taken up by your muscle cells and it's not taken up by your muscle cells because there's a jam or intramyocellular fat, like a layer of fat, fat cells, not a layer of fat cells around your

[07:40] muscle cells. If you can get rid of that, the key will start working again. That is diabetes. So that is type 2 diabetes. Type 1 is a different story and we label it in the same thing. Ideally, I think it should be separate problems, but that is type 2 diabetes when the insulin is produced in excess, but it's not working because of intramyosarilophila

[08:00] So type 1 is there is no insulin at all. Type 2 is there is so much insulin but it is not working because of the blockers and everything. And type 1 is an autoimmune condition. Autoimmune is in your body itself is attacking the pancreas which is making the insulin and you have

[08:20] excess autoimmune antibodies, insulin autoimmune antibodies because of which your body is attacking. So there's a separate tissue going on and here the problem is there's a jam, there's an intramyocellular fat problem. Correct, correct. The intramyocellular fat is linked to gut bacteria. Yeah, yeah, it's linked everything, yeah.

[08:40] So the gut bacteria, because if let's say there is a damage in the gut bacteria, right, or you have an increased proportion of bad gut bacteria compared to good gut bacteria, there is a hormonal imbalance in an hormone called adiponectin. Adiponectin is a hormone which tries to balance the adiponectin.

[09:00] Why Indians have an Indian community have an ethnicity to have a tendency to put belly fat is because of this adipose tissue hypothesis where the adiponectin is supposed to work properly where there is this transmembrane acid fatty acid reflux. So everything

[09:20] thing is on the outside, subcutaneous tissue, but we do not have that much amount of subcutaneous area to store the fat. So it starts to enter myosinear fat. And the visceral fat is being spread into intramyosinear fat and then whatever you explained makes sense. No, but as people, especially when I have diabetes disorder,

[09:40] explaining this whole story to them and then they say no but I'm not fat how will I have intramycellular fat it has nothing to do with your subcutaneous. Subcutaneous fat is the layer of fat below your skin so you have visible obesity. You could be in your ideal body weight rate and still have intramycellular fat. Correct. So if you look at type 1 diabetic people they are actually

Bariatric Surgery and Its Impact on Diabetes Management

[10:00] type 1 diabetes is actually skin. And type 2 it is because of the obesity, insulin resistance you develop obesity and that is why many people recommend that when you lose weight your insulin resistance will also improve because the IMF will also decrease eventually. In fact one of the few things

[10:20] with even if you are losing weight through bariatric surgery or something, you still see an improvement in insulin resistance because you are getting rid of a lot of the visceral fat and intravisal fat. Yes. A small comment on bariatric surgery is people think that surgery is very, very bad and bariatric surgeries are very, very aggressive, but there is a role for them

[10:40] where it is needed, it is needed. So people think bariatric surgery is only for people who are like 200 kilos, 300 kilos. Yes, they need bariatric surgery, but there is an indication for group of people where your body mass index is only 30 to 33. But they have associated problems. We call it as co-modular.

[11:00] where it could be high blood pressure, diabetes or sleep apnea. So, body mass index more than 30 with any other comorbidities, they also meet the criteria for bariatric surgery. So, I just mentioned that because you mentioned about bariatric surgery. So, with this, you explain what is the diabetes of the patient.

[11:20] So I'm sold. So what will you say now? What will you do with me now? So because now we know what diabetes is, we label diabetes as the glucose, carbohydrate intolerance. Okay, I'll just say that again because it's important. We label diabetes as carbohydrate intolerance. Yeah, because

[11:40] Even though all the proteins which we are eating, a percentage of that is also broken down into glucose, fats can also be converted into glucose, but predominantly when you're eating carbohydrates, they are broken down into glucose. So, what is the treatment? Now the treatment is I realize that every time I'm running up and down the stairs really fast, I fall down

[12:00] and I get a fracture. That's this thing. So what will I do? I'll stop running for the rest of my life. I have to work on my agility, right? Right. Okay, so one way of looking at it is stop eating carbs. It's a carbohydrate intolerance. It's not happening with proteins or fats, no? So you stop eating all carbs, it will stop happening. No, you've not removed the log, you've not removed the chewing gum.

[12:20] If you remove the chewing gum, then it doesn't matter if you're eating carbs or not. It's not going to cause your blood sugar to rise right now. The chewing gum is there. That's why it's rising. So actually if you're looking at pre-diabetes remission, getting your pre-diabetes completely into no diabetes state, getting your HPE1C down or even diabetes towards remission,

[12:40] get rid of that intramacyllular fat. How do you do that? Various methods, work on your gut health is one thing, you have to work on your gut health. Obesity management is another. Third, stop eating foods which are causing intramacyllular fat. Fourth, eat fibers which will help you clean that out. So if you can take care of these things and fibers found where? Carbohydrates.

[13:00] So if you go on a low carb, you inevitably sort of go on a low fiber diet unless you very carefully plan it, which is difficult. And then you have to keep measuring food all the time. I can eat this. I can't eat this. This much grams only is allowed because the chewing gum is still there. So if you want to technically go towards getting

[13:20] your body to function like it used to function before. Carbohydrate should be looked at as one part, but cleaning up this intramasalophage should become the primary focus. So now when you're explaining this to clients, they can say, oh, then I can eat roti. Then I can eat rice. Yes, let's work on cleaning up that log. Then you can eat what you

[13:40] eating before and we can get you to a state. That means reducing obesity, it means reducing obesity. But at least you will get to a state where you are eating the foods which you are used to eating. Correct. So in your practice do you say like grams of carbs per day? We know unless it is a type 1 diabetes, yes, we have to calculate because then insulin dose

Dietary Approaches for Diabetes: Whole Food Plant-Based vs. Low-Carb Diets

[14:00] which depends on that. But otherwise, as long as your whole food plant base, you're working on actively cleaning up that lock, which is two processes. Number one, high fiber to help you clean up and improve your gut health. Again, to help you clean up. Number two, stop eating fats. That's what's causing the intramyocellular fats and specifically saturated fats. So if you can take care of these two things, you don't really

[14:20] have to do carbohydrate counting. In fact, we have diabetes patients eating 200 to 250 grams of unprocessed whole food plant-based carbohydrates and not having to worry about, we only see an improvement in A1Cs, we don't see decline. So avoiding saturated fats is example like? Example would be animal fats.

[14:40] would be ghee or certain kinds of oils like coconut oil, which is again saturated fats and ultra-processed foods. But there is a controversy around this, right? About saturated fats. I mean, we cannot completely say, you know, you should avoid coconut oil, ghee altogether. Yeah.

[15:00] Coconut oil from the perspective of it has certain monounsaturated fatty acids. But if you look at the amount, it's very less compared to the saturated fats, number one. Second thing, let's say you have a smoker smoking 10 cigarettes a day and you have a person who's not smoking at all and you have the

[15:20] smoker increases cigarettes from 10 to 12 a day, would the cancer risk increase? Not as much because you are already smoking 10 cigarettes a day, but someone who is not smoking at all, you start asking the person to start smoking, it would increase drastically, right? So this is the same with some of these cholesterol studies where you are saying that someone eating a high

[15:40] cholesterol diet, you're adding a little bit more saturated fats to their diet, their risk of heart disease is not dramatically increasing because you're already starting with a large amount of so where they are, they're going to stay at that. But someone who's on a low cholesterol, low saturated fat diet, you're adding some, you see a drastic increase in terms of their risk. So some part is that and there's also

[16:00] So some studies were read where you're comparing two evils. You're comparing butter to something which is even more unhealthy. You're comparing ghee to something even more unhealthy than ghee. Then ghee does better than something which is animal-lard and ghee. Then ghee will do better. But in that case, you can't say that one evil is better than the evil. So it's not an evil.

[16:20] It would. And when I'm saying we want to keep the fats low, we want to keep it at about 15%, 20% of the total calories, no more than that. And that is actually quite a lot of fat. It's not like a low fat. So in a 2000 calorie diet, 15, 20% would be? 30 grams. 30 grams. 35, 40 grams. 30, 35 grams. Yeah.

[16:40] But that's so long. That's why oil-free cooking is. I think our concentration of fats comes in from processed fats, which is oil-sengy. I see. If you're eating nuts and seeds and like you mentioned the 10 to 15 nuts per day, that'll give you less than 30 grams. But Indian cooking is mixed with oil a lot.

[17:00] Lot of oil, yeah, lot of oil use. And that's why you also see a dramatic improvement in terms of blood sugar level when you ask people to go whole food plant-based within 21 days, sometimes even lesser. So we have clients and, metriculously measured, it is important, diabetes cannot be taken for granted. At least three times in a week we do fasting glucose and then post-parential

[17:20] glucose and you see week one, week two by week three. By week two itself and by week three a drastic difference. HVAC is going down within a span of three months. Three months is what we asked them to test earlier, earlier, but like three months and we see this drastic improvement. No calorie counting. Don't have to worry about carbohydrate counting.

[17:40] towards whole food plant waste, keeping it lower in terms of fat content. So you're decreasing the overall clinical profile in terms of your diabetic patient. The biggest problem sometimes they have is they get very hungry during the snack time. So tips and tricks for that. We do include snacks

Healthy Snacking and Lifestyle Adaptations for Diabetes Patients

[18:00] I think the number of meals per day should be very lifestyle based. You can't do two meals for all, one meal for all, three meals for all. It has to be very lifestyle based. If I do realize a client is very busy in the lunchtime and does not have time genuinely, I'll make sure that it's a dry meal. You can't do a roti sabzi dal, you're busy working and doing multiple things.

[18:20] But having a sandwich or a wrapper or dry meal is easier. So I would do it very specific to that. But when it comes to snacking options, if you're looking for again, fiber and resistance starch rich. So if you want a warmer snack, sundales are a great option, poreals are a great option, those kinds of things. If you want colder snacks, then you can use it.

[18:40] vegetables and air fried sweet potatoes are a great option. So anything which is fiber resistant starch, we are always looking at two things. How do I clean up? Intermyselar fat, how do I stop it from forming? Okay, so when you say how do I clean up, I thought clean up the kitchen. Yeah. No, intermyselar. So you mentioned air fryer.

[19:00] Okay, in your terms about how do you practice? I think we are looking at, we are a generation right now of convenience. If that is keeping you from eating something which is even more processed, it's a very fair price. Air fryer becomes a problem when you're cooking a protein or a fat because of the release of AGs.

[19:20] advanced glycation products. Carbohydrates don't have it. So you could do vegetables air frying and it's okay. It's not a problem. But if it's like a tofu, I would cook it on the stove whilst it's trying to air fry. Example of a vegetable air fryer? You could air fry vegetables in the air fryer. Like sweet potatoes are great. I love doing carrots

[19:40] because it has a really nice caramelized flavor to it. So your recipe is you cut the carrots or whole carrots? Just cut it, cut it. Cut the carrots. Adding a little salt and pepper and just frying, that's it. How many minutes? 20, 25 minutes, but turn it halfway through at about 180 to 200 degrees. That's what I'm doing at home.

[20:00] Nice. And it's amazing. Kale turns out amazing too. I know kale is not very if you live in metro cities, of course, you have access to a lot of kale here. It's grown locally and it belongs to the cabbage family. So it's not like a Western concept. We grew it here. We never knew it was kale. Now we know. So we're using it. But a movie night snack which is

[20:20] famous in my house is kale chips air fried with a little bit of nutritional yeast and salt and pepper and it's very crispy. It has, because cruciferous vegetables, when you air fry them, they have a beautiful caramelized flavor. So if you're air frying like we recently made cabbage pakodas in the air fryer which was

[20:40] basin flour with cabbage and chopped a little bit of green chilies and stuff and it has this really nice caramelized flavor. So cabbage, broccoli, crucified vegetables, cauliflower has a really nice caramelized flavor and crucified vegetables are generally very very healthy for you in terms of disease prevention, reduced cancer.

[21:00] So risk so many things, so many properties. So we like to do that, which is very easy, not very difficult to do. Good, good, good. So wonderful snack option. I'm going to try it out. So carrots, cut it out on the 20 minutes. So do you, hummus, you can use hummus as well for carrots.

[21:20] You can use hormones, you can have by yourself. When we are looking at, no, humans are not designed to go on eating eating. Don't constantly keep eating. So let's say I do have a client who's saying every two hours I'm getting hungry, I would explore things like that. It's a gastric emptying. Is it satiety hormone, secretion, hunger hormone? I would explore. Is it from both?

[21:40] Is it from past lifestyle habits? So we want to start exploring. I think we do have clients where our upbringing plays a big role in terms of that. So where we had a client where resources were less growing up. So it was him and his sibling all the time. And because resources were left, it was also important.

Time-Restricted Eating and Its Benefits for Diabetes Management

[22:00] always a fight for food. Small thing. You don't even think about it. But now growing up has an issue with overeating, not mindful eating, not chewing. Such a small thing. You don't pick it up. But just working in terms of helping the person develop mindful eating habits and saying, it's OK, it's all yours.

[22:20] But then if that is taken care of and you're eating nutritionally dense food for your main meals, you're not going to want to snack multiple times. So I want to understand the habit why you're snacking so many times and then help the person fix the habit. So I'll tell my patients to play a game where they taste the food and then tell the ingredients to the cook who made the

[22:40] That's amazing. That's really amazing. You know why? Not only will it slow them down in terms of eating and more mindfulness, but it's also taking a moment to appreciate the person who's cooked for you, which we don't give credit to, which we never give credit to. Of course. My wife doesn't give it to me. But sometimes I don't cook properly.

[23:00] So that's one of the actually you know if you ask them to chew properly don't look at your phone don't look at your TV that's not going to happen. At least in my practice I've not seen any success with that but this one they are at least appreciating the taste and then some people are very connoisseur of the taste but not many people actually appreciate the taste.

[23:20] either. They just eat food and then they keep warm. So that is one thing I always tell my patients. And what is happening when you are doing the mindful eating, similar to how you are practicing, is your parasympathetic tone kicks in. Exactly. So the vagal tone kicks in, so which helps the digestion a lot better. A lot better. So I

[23:40] say that to all my patients and especially for diabetic patients. So for diabetic patients, white rice or brown rice? We do see a little bit benefit when people switch from white rice to brown rice. I want to say there was a study which showed 16, 20 percent better in terms of in that range. I'm not sure of the number, but 16

[24:00] 16 to 20 percent better blood glucose control in terms of fasting glucose getting better. And that's a huge number for someone with diabetes. That is a big number. So we do see a benefit. I think what we are trying to work when it comes to nutrition, it's unlike a scientist studying and saying this is the right practice. But when it

[24:20] comes to nutrition, it's more in person. You're working with real people who will not listen to you. They will listen to you. So we have to find a way to make it their lifestyle. And especially I practice in Bangalore. Many clients I'm seeing are South Indians. They're rice staple. I grew up in Bangalore. Rice is staple in my house. So I think

[24:40] If I can just get them to understand that diversity of grains is very important. You like your white rice? Okay, let's do it two days of a week. Let's keep the other days for millets or brown rice. But diversity, get the, and translate it. It's a win-win. They feel they've walked out of the consultation getting what they want and they're more likely to follow. But if we do a

[25:00] You only do brown rice. We all know it is unprocessed is definitely better and the more whole the food is, it's definitely better. So I think doing this where a few times if you're doing white rice, it's okay as long as you're doing a diversity of grains and other means. But brown trumps white. And also the amount

[25:20] Amount matters as well. Amount matters if you are not following a lifestyle. So what I also tell my patients that is why we do not do calorie counting because it does play with your mind. I am only allowed one cup. Now I am hungry. Now someone told me I cannot have more than one cup, I am hungry. So what we do in our practice instead is lifestyle changes. Start your meal raw.

[25:40] your meal raw meaning let first part of your meal be salad and it's a part one part two so it should have equal weightage in terms you can't have little salad and then you know so it's a part one part two so it should have equal weightage so let's say you have a bowl of salad salad forces you to slow down it is raw food it requires more chewing it is

The Importance of Sleep and Circadian Rhythm in Diabetes Control

[26:00] is also an appetite suppressor. It's barely any calories, but very rich in terms of volume. It's a lot of food to eat, but not many calories. And it is also high in nutrients, vitamins and minerals which are getting. So when you're starting your meal with a salad, then I don't have to tell someone only to chapati, not to. Because you've started your full by the time. But let's say we start off

[26:20] with you reduce your carbohydrate quantity or fiber or whatever quantity of food, then it becomes like a mind game of I'm on a diet, that's why I'm not allowed to eat this. You do this first, after this you do whatever you want, automatically the second part of treatment. Second part taken care of, okay. In your practice, do you do like time restricted feeding or fasting?

[26:40] in diabetes patients. I love the concept of time risk treating. Such a, so much benefits and really very easy to do. And you don't have to go to 16, 18 hours. You really, you start seeing the benefits in 12 hours. So it is, you know, just 12 hours of fasting, giving your stomach a break and 12 hours of feeding is also good. You want to take

[27:00] it up a little bit more, it's okay. And then depending on your hormonal balance and work with someone who understands and can easily inculcate into your practice. But I think 12 hours is such an easy practice to introduce. What I see a lot of people doing wrong, number one, with diabetes if you're taking insulin or medication and you're doing time-restricted eating, you will get, you

[27:20] might get into hypoglycemia, which is very low blood sugar levels and that is, you know, it's not good, it's not healthy for you because you'll have fluctuations are not good and hypoglycemia itself puts you at the risk of various things including coma. So you could pass out. So when you are doing time-restricted eating and your diabetic work with someone, especially if you're whole food plant-based, you will

[27:40] start seeing your blood glucose drop drastically, your health is improving, you've cleared up those, you know, schwingums. So it's starting to improve. You don't need that much medication. That's why we always work with a diabetologist with us. So as you're healing, you're seeing your measurements, you're seeing your numbers, the diabetologist will help you in terms of tweaking your sort of medication. So time to study

[28:00] Number one, I see people making a mistake with diabetes. You're trying to do it by yourself. No, not doing it. Second mistake I see is people do a very late feeding window. So that means most of your calories are towards the end of the day. And we associate this because food is associated with pleasure generally. And we feel that you be strict first half of the day.

[28:20] eat whatever I want in the evening. Also mostly dinners is a time family sitting together. So you want to sit and you have a, so you'd rather skip breakfast. You're busy. You're not thinking about food, but you want to have dinner. That's a problem. Yeah. So if you see like, you know, some studies done where you've had the feeding window either in the morning four hours or the evening four hours, while the weight loss

[28:40] might be similar, the percentage of body fat drop versus muscle mass drop is different. People who are fasting later in the night are doing better, but people are fasting in the morning and eating in the night, the feeding windows in the night. You see chronic disease markers not improve as much or you don't see the

[29:00] body fat percentage is going up and the muscle mass is dropping. So you do see this difference with regard to. So my suggestion is if you're doing time-restricted eating, do it with the sun cycle. Yeah. So by 7 p.m., finish your window. And nutritionist, you'll have people with different views. There'll be people who will say keto is better. There'll be people who will say high protein.

[29:20] Not a single nutritionist will tell you wake up in the middle of the night and eat. One thing we all agree upon doctors, nutritionists, everyone agrees upon don't eat in the night. I have heard this somewhere. Yeah, in the channel that nutritionists were not. No, in my channel. Where I see it. In my channel. Okay. Yeah.

[29:40] That is one thing that do not wake up in the middle of the night. So that is very important to remember that keep your fasting window as early as possible. Majority of your calories with diabetes management should be in the first half of the day, the breakfast and the lunch part. Keep it lighter towards the evening part. So in my practice, I am a big proponent of high-pressure feeding.

Navigating Social Life and Eating Out with Diabetes

[30:00] I think it's a very sustainable method. Very sustainable. And we start with 12 hours and we maximize to 16 hours if possible. We're very careful on diabetic patients. They are very brittle. See, you see the hypoglycemia, right? The fluctuations so much. Yes, so much. Because the body is anticipating for any tone there, there could be a crack.

[30:20] and everything. Exactly. Especially when they are on insulin. So let us say they are on oral hypoglycemics where it is a tablet. Metformin. Like Metformin and Glipizide. So then the fluctuation is not that much. Yes and but that is also because they have better control, HpM and C is not getting very high. Correct. You will not believe the cutoff for insulin

[30:40] requirement for A1C level. So before A1C level more than 10, then you give insulin. How much is it now? Now it's very low, even more than 7. But is this in India and the US? Both are the same. American Diabetes Association is recommending earlier because the better control of glucose levels sooner. Better risk of chronic disease.

[31:00] disease, other comorbidities. But there is this hesitancy where oh no no you will be dependent on insulin for a long time that is not true. That is not true. So you will take insulin and lifestyle changes. I have seen many patients taken off of insulin as you might have seen. It is just a matter of that removing their IMF.

[31:20] chewing gum that you talked about because the insulin is ready to act. It is just a matter that you need to give rest to the insulin. That is why we differentiate. Type 2 is not type 1. Correct. It is different. So you do not have to treat it like that. Correct. So when a patient is on hemoglobin A1c of 10 and on insulin, time-less rate of

[31:40] can be tricky. Hemoglobin A1c of 7.5 on insulin is okay. But most of the Indian patients that I have seen, they are not on insulin on that particular A1c. Even on HVA1c of 10 to 12, I think it's not a resistance mode because they come and they tell us that doctor told me not needed.

[32:00] doctor probably told needed and they are. I think it's more of a resistance of having to you know poke yourself. Yes, yes, yes that's the key thing. Now the other thing is that okay once you are on insulin you think that you are on insulin forever. And that's not true. That's not true either. So what I do is I maximize the time pressure feeding as much as possible and then I say that

[32:20] So, let us say that you want to start your day at 8 am or 9 am. First thing is 12 hours, 9 am to 9 pm and then you decrease the dinner time as much as possible. As much as possible. And that can only be possible if your sleep is optimum. You cannot be sleeping at 1 am.

[32:40] You know, in fact, yes, because you will start feeling hungry. You will start feeling hungry and then you cannot rely, not only that, but circadian cycle being off is a cause itself for insulin resistance. For instance, there was this study done with women, women who sleep with light completely off in the room. This is a circadian cycle.

[33:00] light cues from the environment. So light completely off in the room, second group with a light on in the room and the third group with a TV on in the room. And no other difference with regard to lifestyle. And you see that the women with light off in the room tend to develop lesser risk for insulin resistance later in life. So that is very important.

[33:20] interesting to see that we are not supposed to be awake in the night and what people will say you're tossing and turning sleep is not coming work on the sleep it's not so start inculcating practices for healthy sleep and there's many things you can do in terms of that you know starting with don't use your bedroom for anything but sleep and sex don't do anything

[33:40] Don't eat on your bedroom, don't have the TV on, don't use it as your workstation. That's the most important thing. People have a laptop on the bed. Exactly. So stop and then make sure you have a sleep routine. Classically condition your mind in terms of you don't have a routine, how will you fall asleep? Yes, the most important factor that might help

[34:00] you in good sleep is going to sleep three hours after your meals or eating three hours before you go to bed. That's exactly that's the most important thing that people should do and the worst thing to do is to have dinner and then go to sleep right away because your digestive hormones are so active and your body is so confused in terms of you know like what do you want me to do

[34:20] What do you want me to do? And that is why if you think if people are listening to this podcast, they can ask the friends around. Let's say they are having dinner and going to bed right away. In the morning, they are going to be groggy. They are going to be groggy. Plus if you have a sleep ring or a watch, you're tracking your sleep.

[34:40] You will see that your deep sleep is not as deep because you just eat and you didn't do any activity and you just went to sleep. So you can see this different in your sleep score when you're sleeping right after a meal or you're not exercising, not exercising, walking. Basic, just allow yourself the time to finish the digestion process and then

[35:00] go to bed. Wonderful. A diabetic patient or any normal patient when they go out for a restaurant, what are your tips and tricks? I think we stick to if it depends on the HPA1C. But if the HPA1C is in the higher range, whole food plant based, so give yourself because it's like saying that right now I have a fracture and

[35:20] And you're telling me, don't dance. How can I not dance? It's not practically possible, but I have to dance. Everyone is dancing. Right now you have a fracture. Don't dance. No, but I will dance. You will get another fracture. Right now you have a fracture. So you can't do the socializing this that when you have a chronic disease right now.

[35:40] fracture ever get off, yes, there will be a time when the fracture will get off, your HPA1C will come down, you will be in a pre-diabetic, you will come into remission. Then can I go out and answer? You should. Go on, because that's a social activity. But right now you have a fracture. So I think that understanding should be there when I'm fighting through a chronic disease. Don't think about, but my social life, but my

CGM Devices, Carbohydrate Fear, and Long-Term Diabetes Reversal

[36:00] Yes, there are other factors right now, the heliobody. And then when you come to a remission state, I think that 80-20, which applies to everyone, all of us, we live in the world of hyperpaltable food. How will you avoid it? We live. I'll walk down from here. There are three to four in this lane itself, the street vendors which are there. So we are living.

[36:20] living in that world. You open any app, you have advertisement for food. And I think we are, I would say, the most beautiful time to be alive, when you can combine, you did the idly pizza, pizza idly, you will not have this any time. You won't have this. So I think you give yourself that 20% of attention.

[36:40] 80% you have to and when you have a fracture you have a fracture. So I think you take a step back in terms of so when I do have diabetes patients which choose whole food plant based restaurants are there you choose that let the HP once they come down and then you have the option to include a lot more freedom and it's okay. So you are you're recommending a

[37:00] against any animal protein at all. Absolutely. Yeah, I know. And I think it becomes harder in terms of people understanding, no, but I want to eat a little bit and inclusion. The best approach is this. Even if you compare the American Dietic Association diet with a whole food plant-based diet, which they

[37:20] been studies done by Dr. Neel Bernard and PCRM Physicians Committee of Responsible Medicine. You see more compliance and sustainability with a whole food plant-based diet versus American Diabetic Association recommended diet. Because it is calculation, it's metricular, it's controlling, and here it is you eat whatever

[37:40] wherever you want to eat, but keep it low fat and keep it free of animal products. Now, do I have patients who say that, no, I want to include a little bit of animal products? And we do see that if you're maintaining an 80-20 ratio, you still see him too, man. You will see. It's not that you're not going to see. But when someone's HVNc is high, it's my moral responsibility to tell you this is the best method for you.

[38:00] Then I can't, ethically I would be telling you the wrong thing that it's okay, you eat a little bit. And I think we have trouble with moderation. I don't think we have, I do realize that we have a moderation problem. Of course, my favorite phrase is moderation is key for which we have lost the key. I agree.

[38:20] So I think that is, we have to be mindful in terms of the choices you're making. Will you see an improvement with AT20? That's a Mediterranean diet. Mediterranean diet is an 80% plant-based and 20% inclusion of animal protein and they do very, very well. So yes, we do see an improvement with that also. So I think we want to see where it really will

[38:40] Let's say you restrict yourself to one meal. I'll go out with friends and I'll enjoy that has animal protein, but the rest of the week I'll eat healthy and you find a way to make healthy and tasty otherwise you won't stick to it. You're obviously going to see a lot of improvement. I think for me when I look at it from moderation perspective, today is just a breakfast buffet.

[39:00] Because we are staying at home, they can go down. There were a series of dessert spreads for breakfast buffet. So you had croissants and muffins and so much of sugary and sweet desserts. And because I follow a whole food plant-based lifestyle and plant-based desserts are very

[39:20] milk and everything. I couldn't eat anything. But because I follow the whole food plant-based lifestyle, I couldn't eat. Had I done the moderation, I would have a little bit today, I'll have a little bit tomorrow. And in my mind, I'm going on convincing myself it's a little bit only. It's less than 20%. But that becomes harder. So the

[39:40] That way, you know, moderation becomes harder when you're that's why it's a lifestyle. It's not a dietary choice. It's this is the lifestyle I want to live. My lifestyle will be whole food plant based. So you go out and options and so then what do you do for deserts then? Oh, we so many. There's ways to cheat. There's a lot of ways to cheat.

[40:00] I was in Spain recently. We've had desserts and burgers every single day. That's a lot of vegan, of course, but so many different options are there. So if I had to find it, in fact, I remember last night I was trying to Google who will deliver me vegan ice cream. So there are ways you can get it if you want to, but it's a little bit inconvenient and because it's inconvenient, it becomes

[40:20] easier to follow the lifestyle much easier. But I think that's what when you have a fracture that time don't answer that time give yourself that and it's easier to stick to it and when you do you know when you are healed you're in a better position have the freedom. But I'm going to be very practical with you even when you have a fracture it is even better

[40:40] to get a fraction rather than finding it. Yeah, that's the mindset and that I think we also want to start thinking that one accessibility. So because we are in Bombay, some of the foods, vada pam, misal pam, sev puri, masala puri, bheil puri, everything is vegan only. So its options are there. So in our mind, we put this thing

[41:00] know that it's not the Italy, dosa is all vegan. It's vegan food by nature. So there's way. Second, we think that it is not tasty. That concept has to change. It's much, much more tastier than so that concept. I think one of the reason we find whole food plant based desserts tastier, you're tasting the real ingredients. Now you have the cashew

[41:20] So in your WFPB, like whole foods plant-based diets, there is no role for animal products at all.

[41:40] No animal products. I differ a little bit where I say that I mean in terms of convenience. I'm just saying if you can do that well, kudos to you. You have surpassed their inconvenience and made their own lifestyle, which is very good. Busy professionals like us and who doesn't, who for us

[42:00] us that inconvenience is a little bit more, I go for plant forward diet. Plant forward diet. Yeah, where the same 80-20, where I eat plants, 20 is animals, animal based. But I understand that there is a slight compromise that I am doing and I will compensate in terms of increasing the

[42:20] and increasing the plan and everything, which is suitable for my lifestyle. And that is where people are at loggerheads that are, you know, you said this is bad. So you cannot do like that because everything is individualized. Yeah, you have to find your lifestyle. So it's very interesting in terms of when I tell lifestyle, you know,

[42:40] I keep like example if I'm telling a client to walk 7,500 steps a day. This is the concept is walk 7,500 steps a day and then the client comes up with counter argument. But that study was done by people who promote the war pedometer and how it's not real and they're making profits. This is the thing. In my mind,

[43:00] what I am thinking is when you are sitting on the sofa, imagine you and your sibling are sitting on the sofa, you are watching TV and the doorbell rings, one of the person will instantly get up, run towards the door to open, the other sibling will sit back, relax and say go, always and you will see that the person who instantly

[43:20] gets up is a person who is healthier. The one who says go, then we say that no, it's my metabolism is low. No, no, that my food, the way I'm dieting, then also not losing. No. The problem is that you have to develop the attitude for getting up and going. How do you develop the attitude? So when I'm seeing a client walk

[43:40] seven thousand five hundred steps a day and there's a follow-up message in the evening did you watch it send me your screenshot of the pedometer and they have just signed up to three days back they are getting irritated of me what what is this I have to pay the money I have to walk what what what does this and it's about 8 p.m. 10 p.m. is a bedtime irritated angry but because they have paid they're

[44:00] do rounds around their bed. They'll send a picture and they'll go to sleep. Second day, again, they'll forget throughout the day, rounds around the bed, send a picture, go to sleep. Third day, when they're reaching work, they've called for the lift and they're thinking, I'm doing rounds anyways around the bed, let me take the stairs, some steps will happen, correct? Fourth day, fifth day, sixth day, after

[44:20] month they'll be the one who instantly get up and open the door. Now I haven't told, now it's not about 7000 getting results of which study was done. The important thing is I've inculcated the attitudinal trait to move more. That is a lifestyle. So if you can make something part of your lifestyle, adopt it. I think 80-20 is fantastic.

[44:40] Because that's also a healthy step in the right direction and this way you've made it a lifestyle also. Correct. So find a way to make things a lifestyle. Incorporate into your daily lifestyle and that is where these consistency always trumps as well. Yes. So there are only two C's. I always say three C's is consistency and convenience will lead to comfort.

[45:00] Wow, amazing. Amazing. Yeah, that's what I usually say, consistency and convenience. And you as a person, individual person, along with your family need to decide which convenience is good for you instead of saying that, okay, you know, your principal is wrong, your principal is wrong.

[45:20] Everybody has to come to a conclusion that it is based on your individual bioavailability and your bioavailability of your environment. It is very important. Otherwise there are constant fights and food fights in the family. Very difficult because the cook gets frustrated. You want oil-free. This one wants oil. This one wants junk food. This one wants oil.

[45:40] So it's very frustrating for the cook. So yeah. So before we wrap this up, I'm going to ask you one thing. What is the one thing that a diabetic patient coming to you, you wish they can change? Understanding, I think the knowledge right now, we've explained one way to reduce your blood sugars, also stop eating foods

[46:00] which are raising, which is carbohydrates, but that's not the solution. You have a wound. Putting a bandage on that understands why you got the wound, so you don't repeat it in the future. But bandading is not a solution. That's why with a high-fat diet, you'll see results because you're not challenging your system. You're eating only fats. You're not eating carbohydrates. You're not challenging the system.

[46:20] But that's not reversal. In fact, if anything, your carbohydrate intolerance goes up further because more intramisol are fasiform. This is a long term intolerance. Then even if you eat a little bit of a banana, suddenly you're seeing a glucose spike, which is not supposed to happen. So I think that understanding, also understanding perspective, that's why a problem I have with CGM devices.

[46:40] Very important. Type 1 diabetes, you need it. It gives us so much of insights. I think uncontrolled diabetes, you need it. You're going into hypoglycemia, suddenly sugar is arising, you need it. Healthy people, you see spikes and you get scared. Then you develop fear of food. Correct. And that's not a nice thing. Correct. I completely agree with you.

[47:00] So I don't think a CGM device should be used by healthy patients or pre-diabetes. You don't need it. You develop fear. And the body's natural responses spike. It's supposed to happen. So don't get scared. So the whole thing, I think when a patient comes in and if I could give one thing, get the mechanism right, stop fearing carbohydrate

[47:20] fix the intramisolapide and go into remission. Don't worry about managing. I really want to touch upon the CGM thing. So, I am a big proponent of Italy. All may realize that Italy was one person who said that Italy raises the CGM glucose levels. The problem with

[47:40] is that that video is very clickbaity and it will go viral because that is something that is very catchy. People are talking about these glucose spikes, you eat this, this is glucose spikes, are not understanding the power of your GI tract.

[48:00] and also your hormones. As you exactly said that if you are normal, healthy and even in pre-diabetes, you will be able to control your glucose by within yourself. It is just when your A1c is more and you are in that fractured state that is where you need some help with the CGA. Yeah and inside because diabetes is very personal, you cannot give us

[48:20] same diet to all, someone's sugar is spiking only towards the evening. Now maybe that's related with stress in the environment, maybe they're coming home, home is stressful, that's why it's rising, you never know. But it's very specific and CGM there can give insights that hey, change the nutrition around them because we are seeing the rise only at this time or during the sleep it's falling, change the dosage of the medication.

[48:40] All that is needed. But I think healthy people, pre-diabetes sold into wearing CTM or doing it because I want to be healthier, you're not going to get insights because you're trying to say that every spike is bad and food is not bad. It's not bad like that. Wonderful. Super. It was a wonderful, wonderful discussion. Awesome. Thank you so much. We learned a lot. I'm sure that in

[49:00] Zodran as well. Thank you so much for your time, Ashish. Thank you for having me. Thank you. Thank you. Bye.